Friday, September 24, 2010

I'm reading a hospital discharge summary, and discovered this quote from a neurosurgery resident:

"The patient was given Valium 10mg and Haldol 10mg. He then become lethargic, with decreasing oxygen saturations. The cause of his sudden lethargy was unclear. A head CT was unremarkable, and a STAT neurology consult was called."

I am not a medical professional of any kind and I know what is wrong with that statement. Anyone sure this resident actually passed his exams? Please tell me, Dr. Grumpy, that you gave him an appropriately smug and smartalecky (is that a word?) response?

@Sunflower RN Those who listeneth not to their nurses are doomed toa) have their patients get worse and go to another doctor b) have their patients think they're idiots and go to another doctorc) have only idiotic patients who will do stupid things thus making them go bald at an early aged) have no respect from their peerse) all of the above

Of course, this is just from one patient's opinion. Mind you, due to circumstances, I've seen a plethora of doctors in my time. Some of them I've fired for this very reason... and then called the insurance company to tell them why I am changing physicians. I am a bad bad woman, I am. OTOH If I have a good doctor, I interact with them as part of my medical team, try to ensure that they get medical records from all of my other doctors, have a list of all of my medications (OTC or scrip), give all of my symptoms (my ped told me to do this in case of differential diagnosis), and follow their orders as we have discussed. Although nowadays I often ask them to write them down so I don't forget them. Harrumph!

misman - one who should act as if they are part of the human race but just misses the point.

I would have been okay if he/she were not a neurosurgery resident but fresh out of med school simply because at this stage of the game, he/she's already had enough experience to know this. Heck, no medical training is necessary to understand that concept, LOL. Or maybe he was just tired.

Must have been annoying to be dragged to the hospital over something like this.

The only reason this would not be flagrant idiocy is if the primary MD/team are the ones who ordered the meds and then flipped out and consulted neurosurgery and neurology. In that case, I can see dictating the note completely straight, because the only alternative is bludgeoning someone to death with the patient's chart. At which point I would promptly be called for a consult on my target for traumatic brain injury.

OTOH, if, as it sounds, the neurosurgery resident is the one who ordered the meds and then flipped out when they worked? I don't know upon what planet that individual would be competent to practice medicine, but it certainly isn't this one.

I had a similar encounter but with a neurology resident. He decided to give an elderly man with already altered mental status 2mg of Dilaudid and 4mg of Ativan before a lumber puncture. I was the senior resident on call for the ICU and got to intubate him an hour later when his pCO2 was 110.

the resident really cannot dictate that, after insisting on overmedicating the patient, the idiot attending demanded a stat neurology consult. or it could have been a clever ploy to get the patient transferred to your service, thereby reducing the neurosurgery workload

In fairness, I don't know if the dictating resident was the one involved in giving the meds, or calling the neurologist. He may have just been the poor sucker who was told to do the dictation, and was reading the chart.

Bahaha. Though as an intern/resident I wonder if someone more senior might have panicked and asked for it "to be safe". Not sure what happens over there but here we don't usually ask for consults without running it past someone more senior. Depends on how senior that resident was though.

no wonder the insurance companies are charging a fortune, is there no accountability ??? How can the cause of the patients lethargy be UNCLEAR??? And to then call a neurologist??? Dont get sick people.

Hospice chaplain wondering if the patient had formulated advance directives before this Baffling Episode. Haloperidol is still a useful drug in palliative care but has to be deployed by someone with a brain.

I'm not a medical professional, so I surmise from reading the comments that the two drugs are both seditives?Every field has their own lingo that people in it understand, while those outside it can try to puzzle it out as a mental exercise.For example, in my own field of mechanical design, I spent the last several days wrestling with "mating conditions". And no, I don't mean giving the pieces of hardware Vi@gr@ and chocolate, as well as a motel room key.I'm off to Wikipedia to look up the two drugs.

Resident gives patient 10 mg diazepam and 10 mg haloperidol, and wonders why the patient suddenly becomes lethargic?! Lights are on but nobody is home - this is someone who should definitely not be a brain surgeon, in any sense of the term.

(Although...I must admit that a smaller dose of haloperidol would likely be more effective for my chronic insomnia than crappy old Ambien CR and all the other stuff I take along with it...)

As a neurosurgery resident I dictate similar things all the time. Trauma patient comes in a little confused and combative (likely drunk) and the ER gives him sedation to calm him down. Then I get a stat page to come assess the patient with a "rapidly declining neuroexam" only to find a snowed patient with a negative head CT. I would be amazed if the neurosurg resident gave the meds, we are stingy bastards when it comes to sedation.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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